Dynamic ultrasound examination of intestinal failure syndrome in patients with severe combined trauma

Objective: to identify ultrasound (US) signs of intestinal failure syndrome (IFS) in patients with combined trauma and to determine their compliance with the clinical classification of IFS. In the process of dynamic ultrasound monitoring in 18 patients on the 5–7th day, gastrointestinal motility recovered with a decrease in intra-abdominal pressure (IAP) to normal, which corresponded to stage I of IIS. In 12 patients, gastrostasis and expansion of the small intestine, an increase in the linear blood flow velocity in the portal vein up to 30 cm/sec, IAP up to 20 mm Hg were observed which corresponded to stage II of IFS. On the 15–20th day, 3 patients with stage III of IFS recovered gastrointestinal motility, 9 patients died due to multiple organ failure. Ultrasound revealed an increase in the liver and spleen with portal hypertension, edema of the walls of the small and large intestines was observed, intra-abdominal pressure increased, which corresponded to stage III of intestinal failure.Results. The results of ultrasound in dynamics with an assessment of the morphological and functional state of the gastrointestinal tract confirm their compliance with the stages of the clinical classification of intestinal failure syndrome. With the help of ultrasound with dopplerography and measurement of IAP, it was possible to objectify the clinical classification of intestinal failure syndrome.

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Intravenous supplementation type and volume are associated with 1-year outcome and major complications in patients with chronic intestinal failure

Gut ◽

10.1136/gutjnl-2018-318172 ◽

2020 ◽

Vol 69 (10) ◽

pp. 1787-1795 ◽

Cited By ~ 6

Author(s):

Loris Pironi ◽

Ezra Steiger ◽

Francisca Joly ◽

Geert J A Wanten ◽

Cecile Chambrier ◽

...

Keyword(s):

Parenteral Nutrition ◽

Malignant Disease ◽

Demographic Data ◽

Intestinal Failure ◽

Underlying Disease ◽

Clinical Classification ◽

Weekly Basis ◽

Research Protocols ◽

The Mean

Background and aimNo marker to categorise the severity of chronic intestinal failure (CIF) has been developed. A 1-year international survey was carried out to investigate whether the European Society for Clinical Nutrition and Metabolism clinical classification of CIF, based on the type and volume of the intravenous supplementation (IVS), could be an indicator of CIF severity.MethodsAt baseline, participating home parenteral nutrition (HPN) centres enrolled all adults with ongoing CIF due to non-malignant disease; demographic data, body mass index, CIF mechanism, underlying disease, HPN duration and IVS category were recorded for each patient. The type of IVS was classified as fluid and electrolyte alone (FE) or parenteral nutrition admixture (PN). The mean daily IVS volume, calculated on a weekly basis, was categorised as <1, 1–2, 2–3 and >3 L/day. The severity of CIF was determined by patient outcome (still on HPN, weaned from HPN, deceased) and the occurrence of major HPN/CIF-related complications: intestinal failure-associated liver disease (IFALD), catheter-related venous thrombosis and catheter-related bloodstream infection (CRBSI).ResultsFifty-one HPN centres included 2194 patients. The analysis showed that both IVS type and volume were independently associated with the odds of weaning from HPN (significantly higher for PN <1 L/day than for FE and all PN >1 L/day), patients’ death (lower for FE, p=0.079), presence of IFALD cholestasis/liver failure and occurrence of CRBSI (significantly higher for PN 2–3 and PN >3 L/day).ConclusionsThe type and volume of IVS required by patients with CIF could be indicators to categorise the severity of CIF in both clinical practice and research protocols.

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